Why are Medicare and Medicaid shown separately instead of combined?

They come from two different CMS data sources with no shared claim identifier, so they can't be reconciled into one number without double-counting or guessing. Every table and chart on this page keeps them fully separate.

Why is there no private/commercial revenue figure?

Private and commercial payer data comes from Transparency in Coverage files, which only publish negotiated rates — not claims or utilization volume. Without a volume figure, no revenue number can be computed for any provider from that data.

What does "Rank" mean in the Competitive Analysis & Benchmarks tables?

For a given CPT/HCPCS code, it's this provider's position by claims volume among all providers billing that same code at that geography level (State, National, or Delaware for Medicaid) — rank 1 means the highest claims volume for that code.

Why is the Medicaid comparison limited to Delaware only?

Medicaid is administered per-state with no single national fee schedule, so a state or national comparison the way Medicare has one isn't available. Delaware (this provider's own state) is the only grouping that's conceptually meaningful.

Why are the numbers rounded to the nearest 10?

To avoid implying more precision than the underlying data supports at a single-provider level. Ratios are kept precise since they're a relative comparison, not a volume or dollar figure.

How current is this data?

The Medicare and Medicaid tables are both single current snapshots, not refreshed on a recurring schedule yet.

Thomas Dougherty (NPI 1043374515)

Thomas Dougherty is a oral and maxillofacial surgery (dentist) provider located in Wilmington, Delaware. This profile covers 9 Medicare and 0 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.

Provider details (source: NPPES NPI Registry)

Medicare: Complete Services Breakdown

Field	Value
Entity Type	Individual
Organization	Thomas Dougherty
Address	5317 Limestone Rd
City	Wilmington
State	DE
ZIP	19808
Taxonomy	Oral and Maxillofacial Surgery (Dentist)
NPI Enumerated	December 20, 2006

Payer Source	Total Paid
Medicare	$38.8K
Medicaid	$0

The CPT/HCPCS codes generating the most Medicare revenue for this provider.

9 rows

CPT/HCPCS Code	Description	Claims	Avg Paid	Revenue
40800	The provider drains fluid from an abscess, cyst, or hematoma, from the vestibule or anterior most portion of the oral cavity of the patient’s mouth. This procedure involves a simple drainage.	100	$140	$13.4K
99205	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the provider…	50	$160	$7.3K
99215	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a high level of medical decision making, and/or the…	50	$110	$5.9K
40801	The provider drains fluid from an abscess, cyst, or hematoma from the vestibule or anterior most portion of the oral cavity of the patient’s mouth. This code is applicable if the procedure requires…	30	$190	$5.2K
99203	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the provider…	50	$80	$3.5K
99204	The provider sees a new patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the provider…	10	$120	$1.5K
99214	The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the…	10	$90	$1.2K
99152	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, in a patient five years of age or…	20	$40	$760
99153	The provider performing a diagnostic or therapeutic procedure administers medication to reduce consciousness, but not render the patient unconscious or asleep, beyond the 15 minutes of intraservice…	20	$10	$160

Thomas Dougherty — Billing Profile & Reimbursement Data

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Medicare: Total Revenue Breakdown by CPT/HCPCS Code

Medicare: Complete Services Breakdown

Medicare: Competitive Analysis & Benchmarks

Frequently Asked Questions

References

CPT/HCPCS Code	Rank	Provider Count	Median Claims	Avg Paid	Average Revenue
99214	1,784	1,830	150	$80	$25.5K
40800	1	10	100	$140	$13.4K
99215	243	570	40	$120	$11K
99204	889	950	30	$110	$6.5K
99205	59	230	30	$150	$6.4K
99203	306	670	40	$70	$5.3K
40801	1	10	30	$190	$5.2K
99153	11	10	100	$10	$1.2K
99152	45	60	80	$10	$1.2K